Why nursing homes won't be catching many breaks this year

When you talk to experts in this field about the year ahead, an unsettling pattern soon emerges. Almost everyone seems fairly confident that regulators will be taking a much closer look at operators.

Among the things we can look forward to in the months to come:

Closer inspections of Medicare bills that are turned in for payments

Closer inspections of corporate integrity arrangements

More incentives to disclose overpayments received

More scrutiny associated with Sunshine Act reporting requirements

More investigations targeting fraud and abuse by providers

Greater data sharing between federal and state anti-fraud programs

Increased False Claims Act litigation.

More could be added, but the point is made. What these developments collectively point to is an inescapable, troubling conclusion: Those outside the business simply don't trust those inside it.

Does that mean the field hasn't made great strides to clean up its act in recent years, to deliver better care or to hold itself more accountable? No. The reality is that this sector is full of caring, ethical people who are trying to do the right thing every day.

But here's the other side of the coin: It's hard for providers to insist they are good neighbors when so many of their peers act like grifters, or worse. Consider this sampling of headlines we've run recently:

It's worth noting that these stories all broke over the last three weeks. It should also be noted that this is a far from complete accounting of the various black-eye developments that occurred.

Am I trying to pick on the good and decent people in this field? Far from it. But here's the thing: It's hard for providers to convince the rest of the world they wear the white hats when troubling developments suggest otherwise. It's apparent that operators will be under increased pressure to hold themselves accountable. As for getting the benefit of any doubts? I wouldn't bet on it.

Next Article in Daily Editors' Notes

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan and Senior Editor Elizabeth Newman.